From the Guidelines
To check if liver function tests (LFTs) are elevated with a FIB-4 score of 0.36, you should order a comprehensive liver panel including ALT, AST, ALP, GGT, total bilirubin, direct bilirubin, albumin, and total protein. A FIB-4 score of 0.36 is actually quite low and suggests minimal liver fibrosis risk, as scores below 1.45 generally indicate a low probability of advanced fibrosis 1. Despite this reassuring score, it's still important to evaluate liver function directly through these laboratory tests to get a complete picture of liver health. The ALT and AST are particularly important as they directly reflect hepatocellular damage, while ALP and GGT provide information about biliary function. Bilirubin levels help assess the liver's ability to process waste products, and albumin levels reflect synthetic function of the liver. These tests together will provide a comprehensive assessment of liver function regardless of the low FIB-4 score. Some key points to consider when interpreting the FIB-4 score include:
- The FIB-4 score is a validated tool for assessing liver fibrosis risk, with scores below 1.45 indicating a low probability of advanced fibrosis 1
- The score is calculated using a simple algorithm based on age, ALT, AST, and platelet count, making it a convenient and widely available tool for clinicians 1
- While the FIB-4 score is useful for assessing liver fibrosis risk, it should be used in conjunction with other laboratory tests and clinical evaluations to get a complete picture of liver health. It's also important to note that the FIB-4 score is not a direct measure of liver function, but rather a predictor of liver fibrosis risk. Therefore, ordering a comprehensive liver panel is still necessary to evaluate liver function directly, even with a low FIB-4 score.
From the Research
Labs to Check if LFT are Elevated with FIB-4 0.36
To determine if liver function tests (LFT) are elevated with a FIB-4 score of 0.36, the following labs can be considered:
- Liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) to assess hepatocellular injury 2
- Alkaline phosphatase to evaluate cholestatic injury 2
- Bilirubin levels to assess for hepatocellular disease or cholestasis 2
- Platelet count, which is a component of the FIB-4 index 3, 4
- ELF test, which can be used in combination with FIB-4 to screen for liver fibrosis 3
Interpretation of FIB-4 Score
A FIB-4 score of 0.36 is considered low, and it is unlikely to indicate significant liver fibrosis 4. However, it is essential to consider other laboratory results and clinical factors to determine the overall liver health.
- A study found that an FIB-4 index <1.45 had a negative predictive value of 94.7% to exclude severe fibrosis 4
- Another study suggested that a sequential test strategy of FIB-4 followed by the ELF test in indeterminate cases can lead to few patients referred for confirmatory liver stiffness measurement, while retaining a high rate of detected cases 3
Association with Liver Cancer and Cardiovascular Events
There is evidence to suggest that an elevated FIB-4 score is associated with an increased incidence of liver cancer 5. However, the association between FIB-4 score and cardiovascular events is unclear, with one study finding no significant association 6.